Mechanical Permit Application

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Application for Mechanical Permit

100 Winnacunnet Road
Hampton, NH 03842

Building Address:*

Unit #:

Map / Lot / Zone

Building Owner:*

Phone Number:

Owner's Street Address:*

City:

State:

Zip Code:

Contractor:*

Phone Number:*

Address:*

City:*

State:*

Zip Code:*

Contractor's License #

Exp. Date

Type of Construction:

New

Remodel

Addition

Alteration

Description of Property:

Commercial

Single Dwelling Unit

Duplex

Multi-Family

Description of what you plan to do:*

Type of Heating System:

Number of Zones:

Type of Fuel:

Propane

Oil

Natural Gas

If LP Tanks:

New

Existing

All LP Installations will need a permit from the Hampton Fire Department as well

Where the Permit should be mailed*

Owner

Contractor

PROCESSING FEE $35 PLUS $5 PER THOUSAND (OR ANY PART OF A THOUSAND) OF VALUE OF CONSTRUCTION TO BE SUBMITTED WITH APPLICATION

Value of Construction: I hereby certify, under penalty of perjury, that all statements given hereon are truthful and accurate, and that the cost of construction, alteration or remodeling (including labor and materials is:

$

I agree to comply with the Town of Hampton's Building and Zoning Ordinance and all work will be constructed in accordance with the New Hampshire State Building Code and related Codes as adopted and in accordance with the plans submitted.

I, The Applicant, do also herby certify that the above project shall not in any way violate any deed restrictions, rights of way, or easements applicable to the property and that I, the Applicant, for myself and my heirs, successors and assigns , do hereby agree to indemnify and hold the Town of Hampton harmless in the event any such restrictions, rights of way, or easements are violated by this project.